714 - Neonatal Embedded Social Support Team (NEST): A Novel Framework for Social Screening in the Nursery

Publication Number: 714.5952

Tzelzin Hernandez, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Valerie Gribben, University of California San Francisco, San Francisco, CA, United States; Denissa Widiarto, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Jessica Esparza Del Toro, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Brendan Terry, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Agustin Diaz, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Mabel A. Chan, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Amy Whittle, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA, United States; Angela M. Casarez, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Leila L. Etemad, University of California San Francisco, San Francisco, CA, United States; McKenna Klein, North Carolina State University, Atlanta, GA, United States; Srujana Rallabandi, University of California, San Francisco, San Francisco, CA, United States; Philip Herrera, UCSF, San francisco, CA, United States; Liza Wu, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States; Sarah Davis, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States; Heather Briscoe, University of California San Francisco, San Francisco, CA, United States; Randi Tanksley, Solid Start, San Francisco, CA, United States

Background: Since 2016, the American Academy of Pediatrics recommends universal screening for social determinants of health (SDOH) in infants. The current standard of care at Zuckerberg San Francisco Hospital (ZSFG), a county safety net hospital with 67% Latine population, is for birthing parents to be screened for SDOH upon admission by the Labor & Delivery (L&D) nursing team and then again by the pediatric team in the NICU/Nursery prior to discharge.

Objective: This project describes an innovative, first-of-its-kind framework for social screening in NICU/Nursery, embedding trained community health workers in the SDOH workflow. This new framework enhances the ease of identification of SDOH needs to efficiently connect families to resources, while simultaneously allowing the medical team to fully focus on the key medical concerns of the infants.

Design/Methods: We conducted qualitative, semi-structured interviews with various stakeholders, including families, healthcare professionals, and social workers, to identify barriers to effective SDOH screening. The medical team identified time constraints and insufficient knowledge and training on follow-up procedures to connect families with resources as major obstacles. To address these barriers, we implemented a pilot protocol from 2/13/24 - 7/24/24 in the NICU/Nursery, diffusing the responsibility for SDOH screening from solely the pediatric physician team by adding days when community health workers were available to do the screening.

Results: During the pilot, the percentage of birthing parents screened on admission by the L&D nursing team who screened positive for any housing need, food insecurity, transportation difficulty, or utilities need was 9.957%. In contrast, when screened by the pediatrics team, 26.003% of patients screened positive for those same needs, indicating that the enhanced screening team detected over double the number of positive screens for social needs. This research compellingly underscores the need for more community health workers to be embedded within inpatient pediatric units.

Conclusion(s): The lower positive screening rate among birthing parents in active labor, compared to Nursery/NICU families, may result from the stress and physical demands of labor, which limit parents’ ability to engage in screening and discussions about social needs. By contrast, longer Nursery/NICU stays allow for more interaction with healthcare teams, leading to more thorough screenings. Next steps could include interviewing patients to explore screening preferences, helping refine the process to be both effective and sensitive to patient needs.

Overall Percentage Positive Responses by Role
CHWs within the NICU/ Nursery team had a significantly higher screening rate compared to HA, Physicians, and RNs​.

Percentage Positive Responses by Department
The NICU/ Nursery team consisting of HA, CHW, and Physicians had over a 2X positivity rate compared to L&D​.

Paper Screening Rate
Overall screening rates increased over time during this pilot's implementation.